2.emergency pre-hospital care

8/4/2019 2.Emergency Pre-Hospital Care

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Community-based

Emergency Health

FRANK ARCHER

Department of Community Emergency Health

and Paramedic Practice

Monash University

MBBS First year 25th February, 2008

Objectives

1. To provide an overview and context ofCommunity-based Emergency HealthServices

2. To provide background for youremergency first aid course this semester

Overview

History

Health Care System

Ambulance Services

EMS System

Emergency Calls

Response Levels Scope of Practice

Clinical approach

Education

Research

Ambulance History

1883 - St John first aidteaching

1887 St John provided

transport

1916 - Ambulance Service

Formed 1961 - Ambulance

Officers Training Centre

Ambulance History

1971 - Mobile IntensiveCare Ambulance

1978 - VocationalEducation Certificate

1988 - Statewide

Defibrillation & ALS

1999 - UniversityDegree at Monash

Available inlibrary


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Message!

Ambulance services are now sophisticated

community-based emergency health services, with a

proud history extending over 100 years and now well

integrated into the health care system

Australian Health System

In Australia, health is a State responsibility

Ambulance is organised at a State level

Each state has a State Ambulance Authority,as a public agency

Most States have an Ambulance Act

All States have a government department

which sets standards and monitors Ambulanceperformance

Ambulance Services

Metropolitan (MAS) and Rural (RAV)

Public Agencies

Committee of Management- Appointed by Minister

CEO- Appointed by Cof M

Executive

Staff : Operational, Support

Clinical Services

Medical Standards Committee

Medical Directors

Clinical Operations Unit- Clinical standards, audit and research

- Clinical training- Clinical support

Education &training

Ambulance and related servicesFirst responders

Community emergency response teams(CERT)

Workplace emergency response teams(WERT)

Voluntary organisations eg St John

Public gatherings eg MCG

Fire Brigade

Other health care providers


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Non-emergency patient

transport

Now regulated by Government

Private patient transport providers

Non-emergency

Moderate acuity from GP clinic or patient

home if seen by GP

Inter-hospital transfers +/- escort

Emergency and Acute

Ambulance services:

Metropolitan (MAS)

Rural (RAV)

Paramedics

Ambulance Paramedics at ALS level

Intensive Care Paramedics (MICA)

Clinical Support Officers

Specialist services:

Air ambulance

Medical retrieval

Disaster response

Ambulance Services

MAS Ops Staff 1200

Sup Staff 200

R/time (50%) 8 mins

R/time (90%) 14 mins

C/load emerg. 240,000

C/load n/emerg 200,000

RAV Ops Staff 840

Sup Staff 100

R/time (50%) 8 mins

R/time (90%) 21 mins

C/load emerg. 80,000

C/load n/emerg 45,000

Patient

QEMSMulti Casuatly and

Disaster Planning Advisory

Committee

Community Initiatives

and First Aid Advisory

Committee

Emergency Medical

Services Specialist

Advisory Panel

Multi Casualty &

Disaster Planning

Network

Community Initiatives

& First Aid

Ambulance Services

QAS/Medical

Advisory Committee

Aero-Health Services

Aero Health Services

Advisory Committee

Definitive Emergency

Medical Services

Other health careproviders


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Contemporary EMS model (USA)

Public safetyPublic health

Health care

EMS

Message!

Ambulance services can provide majorsupport to you as doctors learn how to use

it wisely, and dont abuse it.

There is the opportunity for you as medicalstudents to contribute as a volunteer with

organisations such as St John.

Where we are

Where we

want to be

How to get

there

(NHTSA,1996)

Goal of an EMS System

To get the right response

To the right patient

In the right timeframe

With the right decisions on initial care anddestination,

To obtain the best outcome for the patient In a cost-efficient manner, &

To do it better next time.

Prevention

Public Education

Public Access

Communication Systems

Clinical Care

Education Systems

Evaluation

(Agenda for the Future, 1996)

Integration of Health Services

Medical Direction

EMS Research

Information Systems

Legislation and Regulation

System Finance

Human Resources

EMS System Attributes Metropolitan Ambulance Service

Emergency workload hasincreased about 10% per yearfor the last two to three years!

Why?


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Trends in Health ServicesTrends Impacting on Ambulance Services

Health Care Delivery Methods - Hospital care tocommunity care, eg

De-institutionalisation

Hospital in the Home

Day Surgery

Doctors doing less after hours work

Changing Roles in Health Providers

Evidence-Based Practice

Changing Health Profile of the Population, eg ageing andchronic care

Prevention and Public Health

Health Education and Self-determination

Consumerism, Informed Patients

Contemporary CBEH trends

Transition:

Transport Emergencies Acute/chronic care.

Future:

Chronic care, workforce issues, economies

Who will look after the middle ground?

Health crises, but not emergencies Social support

Community-based acute-on-chronic

Community-based dispositions

Shift the focus from the vehicle to the

Paramedic to the generic provider

Context: Integration

Access CPR Defib ACLSPrevention Hosp.

CHAIN OF SURVIVAL

Message!

Ambulance services can provide major

support to you as doctors learn how to use

it wisely, and dont abuse it.

Emergency

Call 000

Membership: $60 single, $120 family

12 Calltaker Terminals


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2 Emergency Dispatch Terminals1 Non Emergency Dispatch Terminal

MAS Clinicians

MAS clinical tasks:

Discuss with GPs

Talk to hospitalsSupport for EMDsSupport for infield

ParamedicsMAS MD backupAll MICA

Paramedics

Message!

When you call for an ambulance as a

doctor, dont just ask for MICA, but

answer the call takers questions and you

will get the best appropriate response

available at that time

Become an ambulance member it may save

you heaps of money!!


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Current Ambulance ServiceLevels

MAS Response Objective

Right response

To right patient

In right time frame

With safety for everyone

To achieve best patientoutcome

Response Categories

Emergency and Urgent- Codes 1, 2, 3

- Road: MICA, Ambulance, Single Officer

- Air Wing: Helicopter, Fixed Wing

- Urgent inter-hospital transfer, medical retrieval

Patient Transport- Codes 4, 5

- Contracted Services

- Private Patient Transport Services

- Non-urgent inter-hospital transfer

MAS Workload: Top 10 (01)6D1 Breathe prob: severe SOB (Code 1/1)

10D3 Chest pain: sweat/colour (Code 1/1)

--- Dr request


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Bachelor of Emergency Health(Paramedic) Thematic approach

Focus is on Community-based Emergency Health

1. Personal and professional development

2. Population health and illness in society

3. The Paramedic clinician

4. Community-based emergency health in

integrated health and emergency systems

5. Science, knowledge and evidence

Scope of Clinical Practice

AMBULANCE PARAMEDIC: First aid, BLS & non-emergency care, plus:

A - Laryngoscope & Magill forceps, laryngeal mask

B - IPPV & oxygen

C - Defibrillation SAED, Fluid resuscitation

Inhalation analgesia, IV Morphine

Nebulised Salbutamol

Chest pain: GTN (LVF), Asprin

IM package: Narcan, Glucagon, Midazolam, Adrenaline

Triage & time critical guidelines

Scope of Clinical Practice Ctd

MICA PARAMEDIC - Ambulance Paramedic, plus: A - ETT, incl sedation to ETT, muscle relaxants

B - Relief of tension pneumothorax

C - Arrhythmia recognition, cardioversion

Analgesia, IV Morphine

Fluid resuscitation

IV: Salbutamol, Hydrocortisone, 50% Dextrose,Atropine, Adrenaline, Lignocaine, Maxolon, Lasix,Midazolam

Maintain some inter-hospital therapy in stable patients

Trials: hypertonic saline, muscle relaxants

Message!

Ambulance services are now sophisticated

community-based emergency health

services, and provide emergency care at

least at the level expected of a GP in that

setting

Clinical approach

1. Is the scene safe?

Safety survey - D

If not safe ACT NOW!!!

2. Is the patient alive, dead, dying?

Primary survey - R A B C H

If dead or dying ACT NOW!!!

3. If alive, how well or sick is the patient, or is thepatient likely to be sick soon? Main problem and vital signs survey - standards

If sick ACT NOW!!!

4. What other illness or injury is present? Secondary survey

Scene safety


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Patient assessment Clinical problem solving process

Observations gather cues

Assess come to a judgment

Plan develop management plan

Manage carry out management

Evaluate reassess patients status

Message!

Develop and practice clinical thinking skills

in the setting of emergency care

Department of CommunityDepartment of Community

Emergency Health &Emergency Health &

Paramedic PracticeParamedic Practice

Education and Training

MUCAPS is a department in this Faculty, alongwith medicine, nursing and a range of healthsciences

Vocational Education: First aid & Workplace first aid

First responder

Certificate non emergency

Diploma non emergency

University- undergraduate: Diploma - Ambulance Paramedic

Degree - Ambulance Paramedic

Education and Training ctd

University - Graduate:

Grad Cert Aero medical retrieval

Grad Cert Disaster medicine

Grad Dip MICA Paramedic

Master of Emergency Health

PhD


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Message!

Paramedics are now included at degree level

in this Faculty learn from them!!!

EMS System Attribute:EMS Research

QUESTION:

WHAT DOES THE LITERATURE SAYABOUT THE CLINICALEFFECTIVENESS OF OUT-OF-HOSPITAL EMS CARE?

Summary

Little evidence of improved outcome, someevidence of actual HARM from current EMSpractices

Evidence-based policy making with respect to theorganisation of pre-hospital services cannot depend

on RCTs alone. Need to improve methodology Time to move towards addressing a set of outcomes

ofpublic policy importance.

Current research at MUCAPS

Trauma triage

Analgesia in trauma care

Simulation in trauma education

Asthma care

Behavioural responses in acute heath events

Impact of culture on emergency care

Disaster epidemiology

Opportunities for you to do BMed Sc at

MUCAPS after your 3rd year!!!!

Monash University Department ofCommunity Emergency Health and

Paramedic PracticePeninsula Campus

McMahons RoadFrankston Vic 3199Phone: (03) 9904 4638

Email: [email protected] site : http://www.med.monash.edu.au/cehpp

Contact Details

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